Working overtime? At Stanford, physicians bank the time for later

March 13, 2018

Sara Berg

Senior News Writer

American Medical Association

In all walks of medicine, physicians experience multiple demands on their time at work and at home. This can result in increased stress and dissatisfaction, which can compromise success. To address the particular demands faced by their academic physicians, Stanford University School of Medicine has implemented an innovative time-banking program designed to improve doctors’ well-being and reduce the rate of burnout.

Inspired by the idea of faculty trading favors with colleagues to meet the time demands of work and home, time banking for doctors began as a two-year study at Stanford Medicine to help improve physicians’ lives to minimize burnout-induced departures. The study reported benefits to physician health and job satisfaction. The idea has since been successfully implemented within the emergency department (ED), changing the culture by increasing physician recognition and improving morale.

“We don’t just face work-life conflict—the perceived inability to manage both work and life activities—but we also face this idea of work-work conflict,” said Magali Fassiotto, PhD, assistant dean and director of the office of faculty development and diversity at Stanford Medicine. That, she added, is especially the case “in academic medicine, where any given day, or any given week, your time is split between research, clinical care, teaching, mentoring, service and administration.”

“Some of those things get recognized,” Fassiotto said. “For example, all the research you do goes towards promotion, but other activities that are necessary for the institution may not get recognized in a meaningful way.”

At relatively low department cost, this recognition can increase job satisfaction, well-being and perceptions of work-life and work-work flexibility.

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Credits for meal deliveries, dry cleaning

The time-banking system highlights work activities that aren’t typically recognized or that support the flexibility of a colleague. In clinical care, this would include a physician stepping in to fill a shift at the last minute for a colleague who needs support. It can also include teaching or mentoring students and sitting in on an institutional committee.

When these occur, a physician can receive credits to purchase time in the form of academic support activities, such as manuscript editing, grant writing, PowerPoint design help, lab management or speech coaching. Credits can also be used for home-support activities to help free up time including house cleaning, meal deliveries and dry cleaning.

“It’s taking work activities that are essential, but either not fully recognized or they’re supporting the needs of a colleague, and turning those into credits you can use to free up time,” Fassiotto said.

One physician planned to use his credits to help his pregnant wife after she gave birth. He also donated some of his credits to a colleague he knew would be “picking up the slack” for him when he was out.

In ED, personal time urgently needed

After the pilot completed in 2014, the emergency department at Stanford Medicine adapted the time-banking program to fit its individual needs.

“[The ED] has found that it had been incredibly helpful for morale within the team—it increased collegiality,” said Fassiotto. “They also used it in recruitment when they talked about the program to other people and found that having the program made people more appreciative members of the department.”

“For us, one of the things is we have a lot of balls in the air,” said Cori Poffenberger, MD, a clinical assistant professor of emergency medicine and director of faculty development and wellness in the department at Stanford. “A lot of that is your job requirement, but there are always things that come up that you’re asked to do more.”

“Whether it is to cover for a colleague last minute or help teach a course that is not part of your normal duty, we try to do those things because we want to help each other out and we’re good citizens of our workplace,” she said.

“If I volunteer to teach in someone else’s course for an hour or two, then I get credits and I can use that to order groceries because I couldn’t go to the grocery store,” Dr. Poffenberger said. “You can also use the credits, as well, to get grant writing support or help with presentations when you’re giving a lecture.”

“We try to make it really focused on those things that will restore that time to you, given the extra time you’re putting into work,” she added.

Junior faculty members can also earn more credits than their senior counterparts because of their already large clinical load and their desire to publish in peer-reviewed journals. About 70 percent of the time-banking funds that are used in the ED are by junior faculty.

“One of the unintended benefits is that I’ve seen it encourage faculty and residents to be more supportive of each other, to recognize what other faculty members are doing,” said Dr. Poffenberger. “The camaraderie and congeniality in our department has improved because of this program. The message it sends about how we support people is really powerful.”